England’s Chief Inspector of Hospitals has told Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust that it must continue to make improvements following an inspection by the Care Quality Commission.
A team of CQC inspectors visited the trust in December 2017 and January 2018 to check the quality of four core services: urgent and emergency services, medical services, maternity services and children and young people services. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
As a result of this inspection the trust has again been rated Requires Improvement overall, although it was rated Good for well-led being caring and responsiveness.
Inspectors found there was limited assurance about safety, especially within the urgent and emergency care services at Doncaster Royal Infirmary and Bassetlaw District General Hospital.
At the last inspection CQC had identified the need to improve triaging and initial assessment of patients in both emergency departments. At this inspection, the process had changed, although patients were still not receiving a timely assessment. There were extended waits for patients who walked into the department and those who arrived by ambulance which were a potential risk to patient safety.
Although staffing in the emergency departments had increased since the last inspection, neither department was meeting national guidance for the levels of consultant or paediatric trained nursing staff.
On medical wards, all areas visited were clean and well-maintained and staff practised safe infection control techniques. Staff assessed patients for risk of deterioration and escalated their care when necessary. There were safe medical and nurse staffing levels in place and staff said they were supported to develop professionally.
In maternity, the service was not meeting their target of 90% for women receiving one to one care in labour. Doctors and midwives were not up to date with mandatory training or appraisals. Some staff said morale was low.
In services for children and young people, staff cared for patients with kindness and compassion, ensuring they involved patients and their families. But there were significant gaps in the medical staffing.
At trust level, there had been a number of changes within the Board including a new chief executive and chairman who worked well together. The leadership team recognised the training needs of managers at all levels, including themselves, and worked to provide development opportunities for the future of the organisation.
The Chief Inspector of Hospitals, Professor Ted Baker, said:
“Since we last inspected, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust there has clearly been improvement in some areas.
“However it is disappointing that some significant concerns remain, particularly in emergency care where we found the service did not always have enough doctors or nursing staff of the right level to keep patients safe from avoidable harm.
“We found the ambulance handover bays and the overflow areas were cramped and did not provide confidentiality or dignity for patients, who were being nursed in close proximity to each other in an open area.
“I note that since our previous inspection, the trust has appointed a new Chair and Chief Executive who, together with other executive team members, have made efforts to improve services- but we do need to see further progress and improvements embedded.
“We will return in due course to monitor and check that these significant improvements have been made.”
CQC has identified 19 areas where the trust must take action to meet its legal requirements. Full reports including the latest ratings are available online: read the report.
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...it is disappointing that some significant concerns remain
Professor Ted Baker, Chief Inspector of Hospitals